Golden Keys Care Agency Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation people’s safe care and treatment, the ways people’s medicines were managed and safe and effective staffing.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from people and relatives, together with training records, showed some staff did not always demonstrate the knowledge, competence or understanding needed to meet people's needs safely and consistently. This indicated that learning from incidents, complaints, safeguarding concerns and other quality assurance activity was not always effectively embedded across the workforce.

There were processes in place to review incidents, complaints and safeguarding concerns and identify opportunities for learning and improvement. Management described sharing learning with staff and providing additional training where trends or concerns were identified. For example, following concerns about moving and handling practice, leaders introduced face-to-face moving and handling training, competency assessments and changes to staff induction processes. The provider also demonstrated a willingness to reflect on concerns and implement improvements, including changes to out-of-hours arrangements and communication processes.

There were inconsistencies within some care planning records, and documentation did not always demonstrate that specialist advice had been fully incorporated into care plans for people with complex healthcare needs. This increased the risk that staff would not always have access to consistent and up-to-date information to support people safely. Although care plans and risk assessments were reviewed and updated when changes occurred, records did not always clearly evidence how external professional guidance had been reflected in people's planned care.

Despite this, leaders completed assessments before support commenced to determine whether the service could safely meet people's needs. They considered staff skills and compatibility with people's needs and shared information through verbal handovers, care plans and review processes. Staff reported changes in people's needs and worked with healthcare professionals, including district nurses, general practitioners, occupational therapists and social workers, to support positive outcomes and respond to concerns. These arrangements helped staff monitor changes and supported continuity of care when people moved between services or experienced changes in their health and wellbeing.

People were supported by staff who understood their responsibilities to protect them from abuse. Staff received safeguarding training and safeguarding was discussed during meetings and supervision sessions. Leaders maintained safeguarding records, completed investigations and monitored outcomes through audits and action plans. The service demonstrated an open approach to safeguarding concerns and there was evidence of learning being shared with staff following incidents and concerns. Leaders described working closely with local authority safeguarding teams and other professionals to improve outcomes for people. Records showed safeguarding concerns had been investigated, lessons learned identified and actions taken to reduce the risk of recurrence.

The provider did not always support people to manage risks associated with their health, care and wellbeing safely and effectively. Records reviewed did not consistently provide staff with clear, personalised guidance on how identified risks should be managed. We identified gaps in risk assessments relating to falls, choking, diabetes, epilepsy, health deterioration, skin integrity and emergency situations. Daily care records often focused on tasks completed rather than demonstrating ongoing monitoring of identified risks or actions taken in response to changes in people's needs. This meant there was not always assurance that risk management arrangements were consistently implemented, reviewed or monitored, increasing the risk of people receiving unsafe or inconsistent support.

Despite these concerns, people and their relatives were involved in discussions about risks associated with their care and support. Leaders described supporting people to make their own decisions, including where people chose to take positive risks or make unwise decisions. Risk reduction measures were discussed with people, relatives and healthcare professionals, and examples were provided of how people's rights, preferences and independence were balanced with measures to keep them safe.

The provider identified potential risks in the care environment. Environmental risk assessments considered hazards within people's homes and the wider care environment, and staff took action when concerns were identified. Examples included responding to fire risks, arranging environmental adaptations and working with external agencies to address concerns such as infestations and unsafe household equipment. Staff escalated environmental concerns appropriately, and leaders acted to address issues when they were identified. People and relatives generally told us they felt safe receiving care. However, a small number of relatives raised concerns that some staff did not always follow agreed safety measures consistently, including key security arrangements. Leaders responded when concerns were raised and took action to address them.

The provider could not demonstrate all staff had received training relevant to the complex healthcare needs of the people they supported, including diabetes, epilepsy, dysphagia and Parkinson's disease. This meant the provider could not be assured staff possessed the knowledge and competence necessary to carry out their roles safely.

Although systems were in place to recruit staff, monitor staffing levels and provide induction training, we found significant gaps in training. The provider had taken action to improve moving and handling training following concerns raised by the local authority and safeguarding incidents. However, records showed gaps in both mandatory and specialist training. Staff supported people with complex healthcare needs, including Parkinson's disease, epilepsy, diabetes, dementia, dysphagia and stoma care, yet evidence of specialist training in these areas was limited. Not all staff had received learning disability and autism training, which became a legal requirement for all CQC registered providers from 1 July 2022. The provider told us further specialist training was planned and described arrangements to assure staff competency through supervision, observations of practice and practical assessments.

Feedback from people and relatives raised concerns about the capability and confidence of some staff who were unfamiliar with people's needs and routines, particularly in relation to moving and handling, personal care, continuity of care and understanding individual support needs. These concerns reduced assurance that staff consistently had the skills and competence required to provide safe and effective care, although leaders had recognised the concerns and were taking steps to strengthen staff training.

The provider had systems in place to support good infection prevention and control practices. Leaders monitored practice through observations, spot checks and reviews. Care records identified infection risks and staff described responding appropriately to concerns by involving relevant professionals where required. People and relatives told us staff wore appropriate personal protective equipment such as gloves and aprons when supporting people

The provider did not ensure the proper and safe management of medicines. Medicines systems and records did not consistently provide staff with accurate information to support people safely, placing people at risk of avoidable harm. Although the provider had systems in place to support medicines management, including staff training, competency assessments, audits, daily medicines administration record checks and spot checks, these arrangements were not always effective. We identified inconsistencies between care plans, medicines risk assessments and medicines administration records, and documentation did not always clearly identify whether medicines were self-administered, administered by staff, prompted by staff or managed by relatives. There were also ongoing issues with the electronic medicines administration record system, and leaders could not demonstrate the full impact of these issues. Records reviewed identified conflicting medicines instructions, inconsistent administration of time-sensitive medicines and occasions where medicines administration outcomes had not been recorded. 

Medicines information was not always complete and accurate, including information about allergies, medicine strengths and administration arrangements. These discrepancies increased the risk of medicines being administered incorrectly, omitted or administered inconsistently.